Transcript Statistical analysis - Tan Tock Seng Hospital

Was An Emergency Department
Treatment Center (EDTC)
Effective in the Management of
Acute Asthma?
ABISHEGANANDED J1, LATHY PRABHAKARAN 2,
EARNEST A3, LIM G H4, JANE C2, TAN W L4
Respiratory Medicine1 Department of Nursing2,
Clinical Research Unit3, Emergency Medicine4
Tan Tock Seng Hospital, Singapore
Background

One of the common conditions seen at Emergency
Department (ED) is asthma. On average 923 patients
are admitted for asthma at TTSH each year.
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This study looked at decreasing hospitalization rates
for asthma by admitting asthmatics who did not
respond to initial therapy at ED to short-stay units
Literature Review
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Emergency short stay units have been used in the ED
worldwide for several decades.
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Studies have shown that they:
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Reduce length of stay ( Daly S et al; 2003, Rydman RJ et al 1999
& 1997, Khan SA et al; 1997)
Improve ED efficiency (Bazarin J et al; 1996)
Are cost-effective ( Graff L G et al; 1988), and
Reduce the number of inpatient admissions (Martinez E et al;
2001).
Aim Of Study

To determine if the 24 hours Emergency
Department Treatment Centre (EDTC) is effective
in reducing:
In-patient admission rates
 Average Length Of Stay
 Cost
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Criteria to admit to EDTC and
Traditional in-patient wards
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Inclusion Criteria to admit to
EDTC
 Not responding to initial
therapy at ED
 Stable vital signs
 ED re-attenders within
72hrs
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Inclusion Criteria to
admit to traditional inpatient wards
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Severe asthma
Requires extensive
investigation
Need longer duration of
treatment
History of
intubation/ICU care
Significant co-morbidities
Social circumstances
Management of asthma at EDTC
and Traditional in-patient wards
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Medical Management
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As planned in:
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1 day asthma clinical pathway at EDTC
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3 day asthma clinical pathway for traditional in-patient
admission.
Criteria for discharge and transfer to
Inpatient ward from EDTC
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For discharge
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Relief of symptoms
Patient understands
treatment needs
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For transfer to traditional
inpatient ward
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No relief of symptoms
Deterioration in condition
Develop other acute medical
condition requiring inpatient
management
Methodology
Analysis of computer database records of all
asthma patients that were admitted to EDTC and
traditional in-patient ward over a period of Jan – Dec
2006.
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Statistical Analysis
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Software: Stata V 9.2
Method: Logistic regression
All tests conducted at 5% level of significance
Chi-square tests to compare proportions
ANOVA/ Kruskall-Wallis tests to compare
means
Asthma cases seen at ED in 2006
Flow Chart 1:
Total Asthma Cases seen at ED
2471
Admitted Cases
758
EDTC Admission
248
Transferred to In-Patient Ward
67
Treated & Discharge at ED
1711
Direct Traditional in-patient ward admission
510
Treated & Discharged
181
This study looks at asthma
admission to EDTC and
Traditional in-patient ward
Results
Results
Results
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Discharge rates:
The EDTC was able to effectively discharge 73%
(181 of 248 patients) of the asthma patients
 No of beds saved = 181(discharged)
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Readmission rates:
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The 40 days readmission rates of patients discharged
from EDTC was 5.52% (10 patient)
Results
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Average length of stay:
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Direct admission to traditional ward VS Transferred
to traditional ward VS Discharge from EDTC
( 2 days VS 3 days VS 1 day)
Results
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Median Cost
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The median cost of Direct admission to traditional ward
VS Transferred to traditional ward VS Discharge from
EDTC
Median: $528 vs $ 588.88 vs $ 135.85
Discussion
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Our study explored the role of further treatment
at EDTC for stable patients who did not
respond to initial therapy
We found that a significant proportion of
patients can be safely and effectively treated at
the EDTC
This resulted in a safe discharge, shorter stay,
lower cost of care, and beds saved from stay in
EDTC.
Limitation
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Patient who were transferred to in-patient ward from
EDTC stayed 1 day longer (3days) compared to
patients directly admitted to in-patient ward (2 days).
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This can be due to:
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the 3 days in-patient asthma care-path starts as day one when
patient are transferred to in-patient ward even though they
are on day 2 of stay in hospital.
The difference in medical management in the 1 day EDTC
care-path and 3 days in-patient asthma care-path.
Conclusion
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Treatment at an EDTC resulted in
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Safe discharge of 73% of patients
Saving of 181 beds
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Admission of asthma patients to an EDTC did not
result in a higher re-admission rate
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Admission of asthma patients to an EDTC resulted in
cost savings to patients and decreased ALOS
References
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1]
Daly S, Campbell DA, and C. PA, "Short-stay units and observation medicine: a systematic
review," Med. J. Aust, vol. 178, pp. 559-63, 2003.
[2]
Rydman RJ, Roberts RR, Albrecht GL, Zalenski RJ, and M. M, "Patient satisfaction with
an emergency department asthma observation unit," Acad. Emerg. Med, vol. 6, pp. 178-183, 1999.
[3]
Rydman RJ, Roberts RR, and A. G. e. al., "Patient satisfaction with an emergency
department chest pain observation unit.," Ann Emerg Med, vol. 29, pp. 109-15, 1997.
[4]
Khan SA, Millington H, and Miskelly FG, "Benefits of an accident and emergency short
stay ward in the staged hospital care of elderly patients," J. Accid.Emerg.Med, vol. 14, pp. 151-152,
1997.
[5]
Bazarin J, Schneider S, Newman V, and Chodosh J, "Do admitted patients held in the
emergency department impact the through-put of treat and release patients.," Acad. Emerg. Med,
vol. 3, pp. 1113-18, 1996.
[6]
Graff LG, Radford MJ, Gunning MA, and Werne Cs, "The observable patient in the DRG
era," Am.J.Emerg.Med, vol. 3, pp. 93-103, 1988.
[7]
Martinez E, Reily BM, Evan AT, and Roberts RR, "The observation unit: a new interface
between inpatient and outpatient care.," Am. J. Med, vol. 110, pp. 274-7, 2001.